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Solving Price and Complexity Challenges Through Digital Transformation

INDUSTRY
Healthcare

SUMMARY
A sound digital transformation strategy allows AHCS to bring accurate and agreed-upon procedure and pricing information to the patient, before the procedure is performed.

About AHCS
Automated HealthCare Solutions provides ancillary solutions that streamline contact between doctors, patients and insurers. AHCS makes it easy for physicians to verify insurance coverage and guarantee payment. As an industry leader in technology, they navigate the complex documentation required to comply with federal medication tracking and guidelines. AHCS’s solutions allow physicians to dispense medication on site, making treatment more convenient for both physicians and patients. Based in Miramar, Florida, AHCS is the Florida Medical Association’s preferred provider for technology-enabled medication dispensing solutions.

TECHNOLOGIES

  • Microsoft Visual Studio .NET Stack
  • Microsoft BizTalk Int. Server
  • Micro Services
  • Angular.HS. Node.JS. HTML 5v
  • EPIC Electronic Health Recordv
  • SiteCore CMS. MS SQL Server
  • Azure Cloud (PaaS and VMs)
  • MVCS Framework
  • Xamarin Mobile Application Development PlatformSERVICES
  • Onshore and Nearshore Outsourcing of the “Right Fit” team
  • Custom Application Development
  • Training Development and Delivery
  • Business Software Installation
  • IT Implementation Management
  • Post-implementation Support

BUSINESS OUTCOMES

  • Bring providers, payers and patients closer together to a form a true understanding and agreement of healthcare costs
  • Position the healthcare organization as a reliable source of procedure and pricing information
  • Reinforce the healthcare organization’s role as a trusted provider of healthcare procedures

Simplified Systems For Better Patient Outcomes
Healthcare procedure prices have always been “the great unknown.” The same procedure, such as a CT SCAN of the stomach, can range from $180 to $1000s, depending on the provider, the facility and devices used, and the patient’s insurance policy. The range of prices, coupled with the urgency patients feel when trying to schedule procedures, results in confusion and stress. And in the worst case, patients may accept a high-priced procedure not even knowing that a lower cost provider was available just around the corner.

Several social media organizations are trying to improve patient outcomes by providing a holistic view of healthcare costs. By enlisting patients who are willing to provide the prices they were charged for procedures, including receipts or provider statements to validate the pricing information, they are creating an accessible database of healthcare costs that are available for public consumption.

All the Right Data
Automated HealthCare Solutions (AHCS) is a large healthcare organization with a clear digital transformation strategy that includes bringing healthcare procedure and billing information to patients through an actionable system. The challenge for Automated HealthCare Solutions (AHCS) was to combine this user-supplied pricing for procedures with several other data points, including procedure details, inclusions and exclusions, prescription requirements, doctor instructions, insurance approval status, and the amount covered by insurance. Integrating all of this data into a single system would allow patients to accurately see what expenses they would incur before scheduling their procedure.

End-to-End Transparency
In order to provide access to healthcare procedure and billing information to patients, AHCS knew they would need to create a solution based upon agreements with payers and providers, integration with social media platforms and system aggregators, and most importantly, a deep understanding of patient needs.

Knowing that their digital transformation strategy must continually evolve to maintain relevancy, the organization hired AAJ to help define, create, and deliver an innovative solution through iterative phases to meet the following requirements:

  • Aggregate price, procedure and insurance data from several social media and third-party sources into a single system
  • Allow for reviews and rankings of providers by patients and other participants
  • Provide statistical data to all stakeholders and users, including patients, providers, insurance companies, etc.
  • Allow for approval, scheduling and payment of the procedure
  • Have a secure online/live chat mechanism
  • Provide full localization for multi-lingual users
  • Include a responsive user interface with full user-experience capabilities regardless of device or screen size
  • Integrate with third-party systems, such as Uber, Google Maps, etc., to offer a full/one-stop service to the user
  • Meet all HIPAA requirements and additional regulatory standards as needed

Beyond Procedure Scheduling – A Complete Solution
The system, developed in multiple phases, promised immediate results to meet the most critical needs of patients, providers and payers in terms of appointment scheduling. The application provides an end-to-end solution that will:

  • Allow visitors to select procedures they need
  • Select the procedure and doctor based on rankings and pricing, availability, location, etc.
  • Obtain a full-schedule pricing breakdown of the procedure will cost, what is covered by insurance, and any out-of-pocket costs that will be incurred
  • Obtain all requirements to have the procedure performed, including approval by the insurance company
  • Schedule appointment(s)
  • Find directions and transportation to and from appointment(s)
  • Schedule post-procedure visits
  • Maintain an online profile with preferences, past results, schedules, etc.
  • Share online results with the primary doctor and specialists for further evaluation
  • Provide rankings and reviews of providers

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